Wānanga Referral Form
Referring Agency Details
Referrer's Name
First Name
Last Name
Organisation
Organisation's website
Role/Position
Contact Email
example@example.com
Direct Contact Number
Please enter a valid phone number.
Candidate Details
Name
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Email
example@example.com
Phone Number
Please enter a valid phone number.
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Which of the following wānanga are you referring the candidate to?
Ōpōtiki - 15 - 18 February 2024
Ōpōtiki - 18 - 21 April 2024
Ōpōtiki - 20 - 23 June 2024
Candidate Referral
What is the relationship between the referring agency and the candidate?
What aspect of the candidate's background and/or experiences have led the agency to refer the individual to this wānanga?
Please provide any existing evidence that the candidate is motivated to attend and actively participate in the wānanga
Please outline any areas of specific learning areas and support that you feel would benefit the candidate
Please provide any further information that you feel should be considered when reviewing the candidate's suitability for this wānanga
Please confirm that you understand and accept that this referral does not constitute acceptance to the wānanga and that confirmation of the candidate's place will be provided to the agency and the candidate upon completion of the application process, if selected.
I understand and accept
Submit
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